N.Y. to Gay Pride Visitors: Get Meningitis Shot

Action Points

Men planning to attend Gay Pride events in New York later this month and in early July should get vaccinated against meningitis.

Note that the vaccination campaign, started in October 2012, has now resulted in inoculating more than 11,000 people, and officials are urging health authorities and doctors in other cities to tell patients about the outbreak and vaccinate them if they plan to visit New York.

Men planning to attend Gay Pride events in New York later this month and in early July should get vaccinated against meningitis, public health experts are urging.

The warning comes in the wake of an outbreak of bacterial meningitis among men who have sex with men that claimed seven lives, according to Matthew Simon, MD, of Weill Cornell Medical College in New York City, and colleagues.

Between August 2010 and February 2013, 22 cases of invasive meningococcal disease were reported to the New York City Department of Health and Mental Hygiene, Simon and colleagues stated online in Annals of Internal Medicine.

There have also been four cases in Los Angeles since December 2012, they wrote.

The New York health department responded by urging meningococcal vaccination for all city men who have sex with men -- whether or not they have HIV -- if they have engaged in "intimate contact with a man met through an online Web site, digital application, or at a bar or party."

The vaccination campaign, started in October 2012, has now resulted in inoculating more than 11,000 people, the authors reported, and officials are urging health authorities and doctors in other cities to tell patients about the outbreak and vaccinate them if they plan to visit New York.

The vaccination campaign is likely to have had a beneficial effect on the risk of the disease, commented Nancy Khardori, MD, of Eastern Virginia Medical School in Norfolk, Va.

"Nothing in biology is 100%," she told MedPage Today, but the expected efficacy of the modern conjugated vaccine against Neisseria meningitides, the pathogen involved, is about 85%. One important effect of the vaccination program, aside from immunizing men at risk, will have been to reduce the size of the reservoir of men carrying the pathogen, she said.

Lessons learned in the 1980s when the HIV epidemic began "suggest that a successful response requires the coordinated efforts of public health authorities, the government, clinicians, researchers, the pharmaceutical industry, the media, and the community," Simon and colleagues wrote.

Invasive meningococcal disease is currently at an all-time low in the U.S. at 0.3 to 0.6 cases per 100,000 people, but in 2012, the rate among New York men who have sex with men was 50 times higher than in the general population, the authors reported.

The average age of the people in the 22 cases in New York were 34 and half were African-American. More than half (55%) were HIV-positive.

Isolates from patients (all serogroup C) were mostly indistinguishable from each other by pulsed-field gel electrophoresis and were related to a serogroup C outbreak in 2006 among Brooklyn drug users and contacts.

Invasive meningococcal disease patients may die quickly as death within a day after symptoms appear is "common," the authors wrote.

Overall, the death rate among patients with invasive meningococcal disease is about 10% to 15%, but it can be up to three times higher in outbreaks, they added.

The case-fatality rate in the New York outbreak was 32%. Outbreaks among men who have sex with men in Toronto and in Chicago had a combined case-fatality rate of 42%.

Early clinical signs may include an influenza-like illness with severe muscle pain, signs of sepsis, and a petechial rash. Transmission takes place during prolonged direct contact with upper respiratory secretions from colonized or infected people.

It remains unclear, they noted, why outbreaks disproportionately affect men who have sex with men, although epidemiological studies have shown 43% carriage of oropharyngeal N. meningitides, as well as colonization rates of 2% and 1% in the rectum and urethra, respectively.

Khardori noted that it's long been known that transmission of the disease is increased among people in closed or semi-closed environments, such as college dorms or military barracks.

It is likely that in some circumstances, men who have sex with men form such a semi-closed group, she said.

"That's not to say that there might be a risk factor in these patients that makes them more susceptible but as of now we know of none," she added.

Even HIV infection, which might be thought an obvious risk factor, can't be the whole answer, she noted, because several of patients in the current report were HIV-negative.

The analysis was supported by Weill Cornell Medical College. The researchers did not report any potential conflicts.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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